Martin A P, Bartels M, Hauss J, Fangmann J
Department of Visceral and Transplant Surgery, Universitetsklinik Leipzig, Leipzig, Sachsen, Germany.
Transplant Proc. 2007 Dec;39(10):3169-74. doi: 10.1016/j.transproceed.2007.04.025.
On February 27, 2002, the United Network for Organ Sharing (UNOS) introduced a new allocation policy for cadaveric liver transplants, based on the Model for End-Stage Liver Disease (MELD) score. This new policy stratifies the patients based on their risk of death while on the waiting list. We analyzed the background and main features of this new allocation policy to evaluate the effects on waiting list dynamics as well as the accuracy of MELD as a predictor of pretransplantation mortality and posttransplantation outcome. MELD has proved to be accurate as a predictor of waiting list mortality, but seems to be less accurate to predict posttransplantation outcome. Immediate effects of the new policy were a reduction in the waiting list, while organs were primarily directed to sicker patients with reduced waiting times. There was a statistically but not significantly reduced number of patients removed from the list due to death or severity of sickness. The balance between medical urgency and transplant benefit is still to be defined as is the relationship between pretransplantation criteria and posttransplantation outcomes, and the way this relationship should be included in the allocation policy.
2002年2月27日，器官共享联合网络（UNOS）推出了一项基于终末期肝病模型（MELD）评分的尸体肝脏移植新分配政策。这项新政策根据患者在等待名单上的死亡风险对其进行分层。我们分析了这项新分配政策的背景和主要特征，以评估其对等待名单动态的影响，以及MELD作为移植前死亡率和移植后结果预测指标的准确性。事实证明，MELD作为等待名单死亡率的预测指标是准确的，但在预测移植后结果方面似乎不太准确。新政策的直接影响是等待名单人数减少，同时器官主要分配给病情更严重、等待时间更短的患者。因死亡或病情严重程度而从名单上移除的患者数量在统计学上有所减少，但并不显著。医疗紧迫性和移植益处之间的平衡仍有待确定，移植前标准与移植后结果之间的关系以及这种关系应如何纳入分配政策也有待确定。
